Tuesday, August 6, 2013

Birth Control and Breastfeeding: The Silent Topic for World Breastfeeding Week

The variety of information and educational outreach during World Breastfeeding Week is amazing! I've seen articles, memes, studies and even youtube videos promoting every aspect of breastfeeding that you can think of, from history to art, culture to science.

But I find it a little disappointing that one topic remains hidden. And when teased out, met with resistance and polarized fighting. In a community where we carefully analyze every detail, even down to the finer routes of exposure for toxins, why the knee-jerk response to hide our heads in the sand?

Breastfeeding and (hormonal) birth control. People are quick to say it's been proven safe and proven effective. They are quick to say hormonal contraceptives won't interfere with breastfeeding as long as you use the right ones. They are quick to dismiss the many anecdotal accounts that say otherwise and even quicker to ignore the hand of Big Pharma in this topic.

I tried digging around in this topic at the request of a friend today and I sunk so deep into the stinking pit that I couldn't quite decide on how to narrow the scope of such a huge pile of crud. So here are just some basic angles that I skipped across, shared to give you food for thought.

Big Pharma, Birth Control and Formula

So, a lot of people in this natural community dislike "Big Pharma" in general as it's nicknamed. The companies involved are often viewed as suspicious, their products low quality and their studies most likely flawed or tainted with conflict of interest. Scientists and business employees switch from company to company and even move back and forth in our government. It's a big nest for money or scientific fame. That's no different when it comes to this topic. Has anyone noticed that many of the companies or conglomerates responsible for hormonal contraceptives also make or sell infant formula?

We're quick to point out the conflict of interest and ethical problem of, say, Dr. Offit making a vaccine but also sitting on a board and voting for that vaccine.

What about companies making hormonal contraceptives and then making infant formula? Or otherwise promoting, selling and profiting from these two topics?

Teva Pharmaceuticals owns Barr, which owns Duramed. Duramed makes several contraceptives including Paragard and Seasonale. The entire structure also includes about a dozen estrogen mixes including Apri, Aranelle, Enpresse, etc:http://www.ynetnews.com/articles/0,7340,L-4089073,00.html"Materna and Similac face competition: The Teva pharmaceutical company, which specializes in generic drugs, will begin marketing Nutricia's breast milk substitutes in Israel in late 2011."

Nestle [Gerber] and Pfizer also go together when it comes to feeding China's babies:http://www.economist.com/blogs/schumpeter/2012/04/nestl%C3%A9-buys-pfizer-nutrition"Nestlé, the world's biggest food maker, was not the only firm interested in Pfizer's baby-food business. Danone, its big French rival (which is said to have teamed up with Mead Johnson, an American maker of baby food), was also in the running. Yet the Swiss giant had the deeper pockets—and so won the bidding war. On April 23rd Nestlé announced that it would buy Pfizer Nutrition for $11.85 billion, or nearly 20 times its estimated EBITDA"

So that's just a taste of Big Pharma and its roots in birth control and breastfeeding based on how much I was able to dig up while the kids were napping.

No Evidence of Harm....is still no evidence

When it comes to breastfeeding and birth control, every time I broach the topic, I get responses that everything is proven safe and effective. But just a quick smidge of digging seems to say the complete opposite. When big medical organisations are saying the topic is controversial, it's definitely time to reconsider the topic!

American Family Physicians (a lobbying organisation like AAP and ACOG) released a statement on some kinds of hormonal contraceptives. The nuggets in this article are too many to pick out in one blog post and I encourage you to read it carefully and fully:http://www.aafp.org/afp/2005/1001/p1303.html

Here are just a couple highlights for your pleasure:

"Clinical Question

Is breastfeeding safe for infants if their mothers use combined oral contraceptives?

Evidence-Based Answer

There is currently no evidence of harm; however, few patients have been studied and existing studies have many limitations. Therefore, it is not possible to definitively answer this question at this time. The existing low-quality evidence suggests that combined oral contraceptives may reduce the volume of breast milk but not affect the growth of infants. [Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence]"

"Despite the fact that this was the largest and most recent of the three studies in the Cochrane review (it included 171 women and was published in 1984), the data should be interpreted with caution because the loss-to-follow-up rate was greater than 30 percent in both groups. In addition, most of the participants in the trials were using supplemental feedings by the 12th week postpartum; these could have masked any detrimental effect the combined oral contraceptives had on infant growth. The Cochrane reviewers concluded that the evidence from the existing randomized controlled trials was inadequate to make recommendations regarding the effects of hormonal contraceptives in lactation."

"By week 6, 23.5% of women discontinued breast-feeding, and 64.5% of those breast-feeding were supplementing.

CONCLUSION:This study demonstrates that there is no detectable adverse impact on breast-feeding attributable to progestin-only contraceptive methods initiated within the first 3 days post partum."

And once again, we have our modern medical system giving the go-ahead before the evidence. Just use us all as guinea pigs and it will be sorted out later:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012457/"Right now, information is too limited to say whether breastfeeding women should use hormonal birth control or not." (So go ahead, everyone get on it right at 6 weeks PP!)

Anyways, that's a wrap for now. I know I get beat up pretty badly whenever I broach the topic of HRTs (Hormonal Replacement Therapies). But I would be hypocritical if I didn't mention them. And I'm not going to let World Breastfeeding Week pass by without mentioning one of the most common events for the American woman...going onto a hormonal replacement therapy 6 weeks after her baby is born.

Here are a few familiar resources discussing breastfeeding and birth control:

1 comment:

I have to have birth control pills to regulate my cycle, so at my 6 week PP visit my doctor prescribed me the progestin only "mini pill" and Insisted it was completely safe and wouldn't affect my breastfeeding at all, but after a couple days my supply started dropping and by 1 week it was practically gone. Luckily I had been taking fenugreek 4x a day the entire time and because of that my supply was much better within a few days of quitting the pill (though nowhere near what it was) I don't know what I would have done if it hadn't come back so fast, because if course as soon as my supply started going down my son started his growth spurt and I only had a couple days worth of milk pumped. I've been fighting to get my supply back properly ever since and my son is 11 weeks now.